State Medicaid Expansions and Mortality, Revisited: A Cost-Benefit Analysis

Abstract

Previous research found that Medicaid expansions in New York, Arizona, and Maine in the early 2000’s reduced mortality. I revisit this question with improved data and methods, exploring distinct causes of death and presenting a cost-benefit analysis. Differences-in-differences analysis using a propensity-score control group shows that all-cause mortality declined by 6%, with the most robust reductions for healthcare-amenable causes. HIV-related mortality (affected by the recent introduction of antiretrovirals) accounted for 20% of the effect. Mortality changes were closely linked to county-level coverage gains, with one life saved annually for every 239-316 adults gaining insurance. The results imply a cost-per-life saved ranging from $327,000 to $867,000, which compares favorably to most estimates of the value of a statistical life.